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: ^ ill RICE SIXPENCE.
WHAT IT IS,
HOW TO PREVENT IT.
. lb .
UfcUK^fi ROUTLEDGE & SONS,
THE BROADWAY, LUDGATE.
WHAT IS IT!
HOW TO PEEVENT IT.
• • •
• • • 2 ••
• • • • • • •
• •• • • • *
EDWIN LANKESTER, M.D., F.R.S.
MBXBBB 0» THE BOTAL COLLEGE 0» FHY8ICIA2T8, LOWDOWJ IdDIOAX
OF JICEB O* HEALTH 0* ST. JAHES'S, WSSTHUTflSB.
GEORGE ROUTLEDGE AND SONS,
NEW YOEK: 416, BROOMS STREET.
• • •
BATXLL AJTD IDWUtDS, PEI1CTBE3, CHAJTD08 BTEXET,
HISTORY OF CHOLERA 7
IS CHOLERA CONTAGIOUS? . . • .13
SYMPTOMS OF CHOLERA 20
THE POISON OF CHOLERA • . . .24
THE CAUSES OF THE TENDENCY TO TAKE
HOW CHOLERA. POISON IS CONVEYED . • 57
HOW TO PREVENT CHOLERA ... 63
WHAT TO DO WHEN CHOLERA BREAKS OUT . 79
ON DISINFECTANTS 83
Appendix • 90
The following remarks were written at the re-
quest of the publishers, and were undertaken by
the author, in the hope, that they may serve in
some measure to instruct those who may read
them, in the causes and means of preventing
the terrible disease with which the country is at
23, Great Marlborough Street.
August 22, 1866.
There are few epidemic diseases which have
excited more alarm and givon rise to greater
apprehensions than the disease known popularly
as Cholera. Although this name, for a certain
form of disease, has been familiarly known to
medical men from the time of the Greek and
Roman writers on medicine, it has only heen
within the last fifty years that it has gained a
special significance, and has heen associated with
the word Asiatic, to indicate more especially its
origin on the continent of Asia. Previous to
its outhreak in Hindostan, in 1817, the disease
known by the name of cholera had never been
seen as an epidemic disease in Europe, and
certainly had never heen regarded as contagious.
In the autumn of the year in most countries of
Europe, and also in Great Britain, the disease
called cholera was familiar, and medical writers
called it Cholera Morbus. This disease was
attended with the symptoms ol ^at^jsnj, w 1 ^
HISTORY OF CHOLERA.
vomiting, and seemed to be an exaggeration of
the state of system in which diarrhoea usually
i. It was frequently fatal, and morB
prevalent in some places than in others.
It was between the years [817 and 1830 that
aocounis were brought from our possessions in
the East Indies that created alarm, lest the
disease, which had devastated Hiudostan, should
by any means be conveyed to this country. The
history of its outbreaks and the facts of its
propagation showed that it might he conveyed
in any direction along the lines of human inter-
The first accounts we heard of the disease
were from places situated on the delta of the
Ganges, where it appeared at the end of May or
the beginning of June, 1817. From this spot,
in the years 1818-19, it extended itself through
the whole of the Indian peninsula. In 1820 it
found its way to China, and in the following
year ravaged the populsus islands of the Indian
Archipelago. In the same year it .appeared
on the shores of the Persian Gulf, spreading
to parts of Arabia, Syria, and Persia, thus
threatening Europe. In 1823 it was first seen
in Russian territory, in Tiflis, Orenberg, and
AstracRB. Here the disease seemed for a time
» have been arrested, hut it again VtoYs <M>
in Oreubcrg in 1828, and in 1830 advanced to
the southern frontiers of the Russian empire, in
which year Moscow was attacked. In March,
1831, the disease was at Warsaw, in May it ap-
peared at Dautzig, and in Sunderland in October
of the same year. In the following year it
broke out in Paris and in London. In all thi
places the disease appeared suddenly, and spn
with irresistible force, speedily attaininj
maximum of mortality, and then us sudderil
retiring. After this first outbreak of the disei
in Europe it again disappeared, but another out
break was again reported in India, which, tra-
velling in almost the same route, appeared in
Europe in the years 1847-48, and 49. Again
London and many of the great towns of Eng-
land were attacked, and again became free from
the disease. A third visitation occurred in
the years 1852-3-4. London was visited in
the latter year, and although the mortality was
not so large as in the previous attacks, the
disease appeared to have lost none of its viru-
lence, and the number which died, in proportion
to those attacked, was about the same.
In.I8G-i this disease was again announced as
invading Europe, and, in this instance, the line
of its advance was somewhat different. We
were first alarmed by the ys.^to w ^ q ' ^ '^wSws"*"
10 HISTORY OF CHOLERA.
for the fourth time, by reports of its appearance
in Egypt, more especially along the march of
the army of pilgrims from Mecca. The disease
was clearly not generated at Mecca, but brought
there by Mohammedan pilgrims from the East.*
From Mecca it was brought by the returning
pilgrims to Alexandria, and thence along the
ports of the Mediterranean to Southern Europe.
The localities of tho first attacks in England
were' somewhat different. In previous attacks
it had first appeared in the north. This time
we heard of it first in the south. It first
appeared at Southampton on the 10th of
July, and subsequently was reported at Wey-
mouth, Portland, and Dorchester. One of the
most singular episodes in the history of the
arrival of cholera in England in 1805, was its
appearance in a small village named Theyden-
Eois, near Epping. Here lived a farmer who,
with his wife, went to spend a fortnight at
Weymouth in September last. On returning
home he was seized with diarrhoea. Ho, how-
ever, arrived at home on the 26th of September.
His wife, after getting home, was attacked with
tho same complaint, and died on the 11th of
October, with all the symptoms of cholera.
By Tilbary Fox, MD.
HISTORY OF CHOLERA. 11'
Subsequently the farmer himself died, and of
eleven members of his family attached, eight died-
It was found in this case, that all the drinking
water of the household came from a well iuto
which tbe soahings of the water-closet con-
tinually flowed. The conclusion arrived at in
this case was that the farmer bad contracted the
disease in the south of England, and poisoned
the well from which his family partook their
drinking water. A curious point iu connexion
with this case has been pointed out, and that
is, that the sewage of this house flowed into
tbe river Coffin, a little stream which empties
into the river Lea*
As to how the outbreak occurred at South-
ampton there can he little doubt, as several
vessels had arrived there from the Mediterra-
nean with cholera on hoard. In the same man-
ner cholera appeared on board emigrant ships
coming from Holland with German emigrants
on board. Cholera having prevailed extensively
in Rotterdam and other cities on the Continent
during the summer of I8G5, explains the cause
of the outbreak in these ships.
These, then, were the principal indications
that we had iu 18(i5 that we might apprehend
* " Eighth llcport of the Medical Officer of thu Pclv^
Council, with Appendix." IftEiQ.
HISTORY OF CHOLERA.
an outbreak of cholera in London, Soutbamptoi
or Liverpool in 1806. In June of this year
•was announced that cholera cases had occurri
again in Southampton nnd Liverpool, whilst a
larger amount of diarrhoea than usual occurred
in London. It waa not, however, till the 2nd
of July that the mortality assumed a serious
aspect; it was then found from the weekly
return of the Registrar- General that the deaths
which were 1292 on tho 7th of July were 1B4I
on the 14th, 1798 on the 21st, and 2600 on tl
28th of July.
The mortality of London was doubled by this
explosion of cholera, and the greatest anxiety
prevailed lest the disease which bad so suddenly
broke out should extend in all directions. It
was soon, however, found that the attack waa
confined to the east end of London. It was
further observed that the cases principally
occurred in those districts of London compris-
ing Wbitechapel, Bethnal Green, Bow, and
Poplar, supplied with water by the river Lea.
It was also found that this district waa the only
one in London to which the great main drainage
works now being completed bad not extended,
On these grounds a hope was expressed that
the disease might not extend to other parts of
-London, But should this hope lead to care-
HISTORY OF CHOLERA 13
lessness on the part of individuals, and neglect
on the part of public authorities, a single case
imported from the infected district may be the
means of a similar explosion in any other part of
London. It is with the object of preparing the
public to understand the nature of this terrible
pestilence, and to put them in a position to
resist its influence, and prevent its spread, that
these pages are written. It is not by keep-
ing the public in ignorance of the nature of
this disease that any good can be done ; but
it is by imparting an intelligent apprehension
of the great natural laws involved in the course
and progress of this disease that we may hope
to deprive it of its fatality, and even convert its
awful presence into a future blessing.
IS CHOLERA CONTAGIOUS ?
After the previous history, it would appear to
some people almost superfluous to ask this
question. A disease which is traced from a
central locality, whioh has constantly been
carried from that spot by human intercourse,
that is never known to spring up spontaneously,
but always to travel through the agency of in-
fected persons, bears all the character of a con-
tagious disease, and the facts will hardly bear
interpretation in any other way. Nevertheless,
great donbt3 have been thrown upon the theory
of its contagiousness. Many of the govern-
ments of Europe have treated it at times as
non-contagious, and none more obviously than
our own, and there are many distinguished
medical men even at the present time who
. maintain that the disease is not contagions
Unlooked for as it might be, there is evidence
to show that the maintenance of these oppo-
site opinions about the contagiousness of cer-
tain diseases is not altogether unconnected
18 CHOLEKA CONTAGIOUS ? 1.
with political views. Thus during the early
part of this century the free-trade party i
most earnest in their efforts to induce the
governments of Europe to abandon the quaran-
tine of vessels proceeding from infected ports.
In order to gain this end they endeavoured to
show that the plague and other diseases for
which quarantine had been established were not
contagious. This party foresaw that the arrival
of cholera would be the signal for securing
obstructive quarantine regulations, and some of
their leading men were distinguished for their
maintenance of the theory of the non-conta-
giousness of cholera. Our government has
always more or less leaned to this theory, and
the most distinguished members of its sanitary
boards have heen non-oontagionists. It ought,
however, to be known that several of the scien-
tific and medical gentlemen employed by the
government have from time to time given in
their adherence to the theory of contagion, and
the recent reports of government agents confirm
this theory, and the late regulations issued by
the Privy Council* recognise to its fullest
possible extent the theory that cholera owes
its origin and extension to a poison secreted in
the mucous membrane of the alimentary canal.
* " Orders of Privy Council m. ietoi3s& Va CuJjctv"
1G IS CHOLERA CONTAGIOUS?
If cholera ia not produced by contagion, the
question comes as to what are its originating
causes. Now, we are not without evidence to
show that certain diseases arise and spread quite
independent of any poison propagated within the
human body. Thus we are familiar with a dis-
ease in England known by the name of " ague,"
which evidently originates in a poison which is
generated outside the human body. This poison,
which without having been examined or even
seen, we call malaria, is generated by decom-
posing vegetable matter. We know the districts
where it prevails — we know where it will pre-
vail most, and we can at will remove the cause.
In the same way the simple diarrhcea of this
country occurs at a certain season of the year,
it arises from definite causes; and here there is
no specific poison or contagion passing from one
body to another, and maintaining and spreading
the disease. Reasoning from analogy there is no
doubt that those who advocate the non-conta-
giousness of cholera should point to our summer
diarrhcea as the type of the more fatal disease,
and that cholera is only, as it were, an intensi-
fication of diarrhcea by certain meteorological
conditions acting upon systems made susceptible
by the unsauitary circumstances in which they
have lived. Now these- two points have been
most carefully examined. During tiie e^Aaiavis
13 CHOLERA CONTAGIOUS 7 17
of 1848 and 1854 careful observations were made
in London of the state of the atmosphere ; but
although every condition was investigated with
great laboriousness, no special conditions could
be discovered which were connected with out-
breaks of cholera. The disease has sometimes
prevailed in mid-winter, whilst undoubtedly its
attacks are more frequent in hot summer; but
heat cannot be regarded as a cause. Humid
atmospheres and climates seem to favour its
attacks J but the cause of cholera has never
been traced in any districts to humidity,
is the same with other conditions of the air, its
electricity, the presence of ozone, its density and
elasticity have been all carefully examined, but
no one of them, by their constant presence or
absence, could for a moment be regarded as the
cause of cholera. So recently as the outbreak of
the cholera at Southampton in 1 865, the attack was
investigated in reference to the meteorological
conditions in that town ; and this was done with
the ample resources of the Meteorological Ap-
paratus of the Ordnance Survey Office in that
town,* Careful observations made during the
months of August and September showed that
during the first month there was no unusual me-
» See Dr. Parkes' Report in "Eighth Report of tlw
Medical Officer of Privy Council."
18 IS CHOLERA CONTAGIOUS?
teorological condition except an excess of rain,
and in the last month an excess of heat and no
rain. The experience in otber parts of the world
has been the same : there is no condition of
atmosphere ami season that can be laid hold of
as the cause of cholera. There is one other
point connected with the state of the air which
was investigated at Southampton, and that is,
the question of the possibility of the cholera
miasm having been brought from a distance by
prevailing winds. It was found that both before
and during the pre valence of cholera the wind
was blowing in all directions, and there was not
the slightest evidence to show that any foreign
or poisonous matter had been conveyed to the
town by that agency.
The second point on which the non-conta«
gionista fay great stress is the occurrence of
choleraindistricts where unfavourable local condi-
tions exist. There is no doubt that cholera is most
virulent and fatal in those towns and districts
of towns where dirt and filth, and poverty and
neglect of sanitary laws prevail. But we have
yet to receive the facts on which the theory can
be established that cholera is produced by any
combination of organic and inorganic matters
independent of a special poison. There ia
nothiag more striking in the liiatovif of cholera
outbreaks than to find it passing onei\ioAiae&,&*&-
IB CHOLERA CONTAGIOUS? 19
tricts, and towns remarkable for their deficient
sanitary arrangements and general insalubrity - )
and fixing itself in localities where sanitary
agencies have been comparatively active. Upon
the -dirt and filth theory, how could we account
for the outbreak at Southampton ? It was not
in the dirtiest parts of Southampton and its
neighbourhood that it occurred at all, hut here
and there in isolated spots ; and to nearly all
these spots the cholera was traced from on board
the ships which had arrived from the Mediter-
ranean with cholera on board.
It has been by the entire failure of any other
theory to account for the spread of cholera that
inquirers have been driven to accept the theory
that the disease is contagious, and that it is only
propagated by a poison which being generated
in one body 19 communicated to another. If
there were only a probability of this being the
true state of things, it is oT the utmost im-
portance in all attempts to prevent the spread
of the disease that this should he recognised,
and that our efforts should be directed to the
covering of both issues. All who have anything
to do with cholera should act as though it were
the most contagious of diseases, aud not neglect
the removal of dirt and filth, as though they
were the real producers o£ t\ia cBAWttoA."i»
SYMPTOMS OF CHOLERA.
The duration of nn attack of cbolera v
two or three hours to several days. Medical
men recognise three stages: — 1. A premonitory
stage. 2. The stage of collapse. 3. The febrile
or reactionary stage.
The premonitory stage is tliat in which the
symptoms are those of ordinary diarrhrea. There
is looseness of the howels, with or without
pain. In this stage cholera is not to be distin-
guished from ordinary diarrhoea. It is, however,
of the utmost importance when cholera is prevail-
ing that no case of diarrhcea should be treated
as merely an ordinary case of that disease, aa
all experience shows that where this premonitory
diarrluea is early attacked it may be arrested and
the- more formidable symptoms of cholera pre-
vented. At the same time there are, no doubt,
cases m which these preliminary symptoms
suddenly pass into the subsequent stages, kq&.
SYMPTOMS OF CHOLERA. 'i\
forbid anything like treatment that would lead
to the arrest of the disease.
The second or cold stage of collapse is cha-
racterized by both purging and vomiting. The
stools cousist of a watery, colourless fluid, with-
out smell, and having the appearance of barley
or rice water. In this fluid are observed flakes
of an nlbiiminous character floating about.
Whilst these discharges are very frequent, the
patient complains of severe cramps, especially
in the legs. These symptoms are accompanied
with great exhaustion, giddiness, and general
weakness. The pulse becomes small, frequent,
and accelerated, and as the disease advances,
almost imperceptible. The skin becomes cold
and is covered with a profuse sweat or a
clammy moisture. The temperature of the
whole body is perceptibly lower. A thermometer
placed under the tongue will indicate a tempe-
rature much below the natural heat of the body.
There is great restlessness ; the patient, though
so cold, complains of heat and throws off the
bedclothes. There is great thirst and pain at
the pit of the stomach, and the respirations are
much more frequent than usual. The features
are shrunk and anxious, the eyes are dull and
suffused, the tongue is moist but cold, the wto
is feeble, hollow, and hoarse, wai. ^erj «3mss
22 SYMPTOMS OF CHOLERA.
teristic of the disease. As the disease advances
the skin is not only cold but blue. Hence tha
names Algide Cholera and Blue Cholera which
have been applied to this disease. The functions
of the brain remain unimpaired to the last. As
the disease advances the urine becomes sup-
pressed, the pulse becomes smaller, and the
patient dies of exhaustion. Death sometimes
comes on very rapidly in this stage without all
the symptoms being doveloped. In other cases
all these symptoms continue for many hours or
even days, and eventually the third stage, that
of consecutive or reactionary fever sets in,
In this stage the coldness and blueness of the
skin gradually disappear, the pulse acquires in-
creasing force, the face becomes flushed, the
vomiting is less frequent, the diarrbcea continues.
The urine is secreted again, and other favourable
symptoms are observed. Although this stage is
indicative of an ability on the part of the patient
to resist the disease, lie not unfrequently suc-
cumbs, and dies from exhaustion some days, or
even weeks, after his first attack.
As the object of these pages is not the in-
struction of the medical student, we shall not
pursue the question of the symptoms of thi3
disease any further, nor shall we enter into the
question of the causes of the symptoms ^«\i\c\\
SYMPTOMS OF CHOLERA. 23
are presented in its course. Melancholy as is the
duty of watching hy the bedside of the suffering,
and painful as the attendance upon the sick who
cannot be rescued from their fate maybe, there
is after all a profound interest awakened in the
inquiring mind as to the nature of that poison
which invisibly introduced into the system of
the living man so soon acts upou every organ,
and in so many instances destroys the fabric of
the most perfect organism in the course of a
few hours. The havoc of the tornado in i
tropical forest gives but a faint imago of the
effects of this poison when once it has gained
access to the wonderful mechanism of the liumai
The intense* interest excited in the mind of
the scientific inquirer, is the guarantee that as
long as this disease shall be a scourge to man-
kind, so long will there be intense minute and
anxious research into the nature of that chain of
causes which results in the wonderful and disas-
trous effects of this disease upon the human body.
THE POISON OF CHOLERA.
All contagious diseases are the result of three
great factors, tho absence of any one of which
must prevent an epidemic.
There must he first a special poison ; second,
a person -predisposed to take that poison; and
third, a medium conveying the poison to the
predisposed individual. In other words there
must he a poison-maker, a poison-taker, and a
poison-bearer. Unless these three things nre
present there will be no spread of contagious
disease, and I may illustrate this position by
what takes place in a disease which is uni-
versally admitted to be contagious, I mean small-
pox. In order to propagate this disease there
must be, first, the poison-matter from n small-
pox pustule; secondly, a person predisposed
to take the disease ; and thirdly, a medium
for the conveyance of the poison, either the
point of a lancet inserted into tho flesh, or an
atmosphere to convey the poisonous getm. \l
THE POI30S OF CHOLER.
the poison is not there no amount of prodi:
position will serve to engender the di
Again, if tho poison be there and the predi
posed person — nnleBS some medium is presenl
unless the poison is conveyed to the predisposed
person, there will he no produotion of the di:
A person predisposed to take the small-pox
may stand by the bedside of one who has the
disease, but if the current of air blows awa;
from the predisposed person, the poison will n<
come near him, and he will escape ; or the atmo>
sphere in which both are placed may be so ex-
tensive, that the poison being diluted will not act
upon the predisposed individual. But let the
poison be ever so intense, and tho medium ever
so ready to convey it, if tho unaffected individual
has been vaccinated, he is not predisposed
take small-pox, aud he will not contract tho dh
ease. There is no problem in our social life
which people ought to study with greater dili-
gence than this. It is the key to the suppres-
sion of contagious diseases, and the delivery
mankind from at least half the causes of thei
disease and death. Let us, then, study cholei
from these three points, and first ascertain win
we know about the poison of cholera.
At first sight it might a^oeat feA. -^^ cw&S
know nothing about tiie \a."«B viWa. tw&N&s^a^
26 THE FOISON OF CIIOI.ETU.
nature of a poison whose presence we had never
been able to detect, and whose very existence
has been denied. But when we oall to mind the
fact that the poisons of ague, of scarlet fever, of
diphtheria, of measles, and of hooping-cotigh,
have never yet been separated and observed, and
that few are bold enough to deny their existence,
we shall see that the poison of cholera may be
regarded as a special existence, as much as any
of these poisons. In the case of small-pox
above alluded to, we have been able to separate
the poison. We know that it consists of par-
ticles of matter which have been generated in
pustules in the skin, and reasoning by analogy,
we are led to believe that the germs which pro-
duce scarlet fever and measles, are likewise pro-
duced upon the skin. There is a close resent
hlance between the structure of the skin and the
mucous membranes of the alimentary canal.
Now, cholera is eminently an affection of the
roncous membranes of the stomach and howels,
and we have thus reason to believe that just as
poison germs or cells are thrown off the struc-
ture of the skin in small-pox and scarlet fever,
so poisonous cells or germs arc thrown off from
the mucous membranes of the howels during an
attack of cholera. The difference between the
ordinary discharges of the bowels m\1 Voose
THE POISON OF CHOLERA.
which take place in cholera, 19 as great as the
difference between ordinary perspiration and the
exhalations which pass off from the skin in
scarlet fever. One is perfectly harmless, the
other produces n specific disease.
Cholera is not the only disease which affects
the lining membrane of the stomach and bowels,
and whose action is to produce a poison on the
mucous membrane. There is a disease very com-
mon in this country, known as gastric or typhoid
fever,the disease to which the late Prince Consort
fell a victim, which consists in an affection of
the mucous membrane of the bowels, and which
renders the discharges from the barrels highly
contagious. This disease in the mode of its
propagation, and the nature of its poison, greatly
resembles cholera, but the action of its poison
is not so sudden or fatal as that of cholera ; and
being a native of our own soil, and constantly
amongst us, we give it much less attention than
we do to the stranger from the East, who
stalks in upon us occasionally and alarms us so
much, although in the last twenty-five years it
has done us infinitely more harm. We shall
have reason after all to thank the stranger, if he
teaches us how to destroy his brother, who ia
native to our shores-
All the evidence on •fllawV^e tcV* tot igtw-as^
88 THE POISON OF CHOLERA.
that cholera is a contagious disease, points to
the evacuations of the patient as containing
the poieou germs. How these poison germs
are distributed may be more easily conceived
than described. But in a large Dumber of iso-
lated cases of the occurrence of this disease, un-
mistakeable indications of contact with the poison
germs from the evacuations are given. Thesa
germs, although more easily communicated
through the agency of water, can undoubtedly
he received through the air. Thus we fini
persons frequenting water-closets where cholera
patients have been, have contracted the disease.
Tins was probably the way in which the farmer
at Theyden-Bois, near Epping, first contracted
the disease, which he carried from Weymouth to
his home, and which produced such fatal effects
in his family.
In one of the cases at Southampton, bo ela-
borately detailed in the report of the Medical
Officer of Health of the Privy Council,
found that one of the persons who died had
been engaged the day before in attempting to
unstop with a stick a public water-closet which
had got blocked up with feculent matter. In a
large number of cases the breaking out of cho-
lera in an uninfected district has been clearly
traced io persons coming from infected districts.
Take the followir. | ^ liat when ^
A boy aged 8 year H "f^JT °PP°sed.
the 7th of August 6 ^ S^ of fl ny
ill of cholera, to s * | J^ '
uninfected street at '^
He was attacked w; a ■%
Friday, the 9th of A
uncle, who had not b
trict, had the disease
August. This could nfitdly he a coincidence,
and could be explained on no other theory than
the hoy bringing the disease from a place where
it existed, and communicating it to an indi-
vidual where tha disease had not previously
Another set of cases, which show the conta-
giousness of cholera, are those in which persons
who wash the clothes of those who have died
of this disease have been seized with cholera.
All these instances seem to prove that the
cholera poison may be conveyed through the
air as a medium. Another curious set of cnse3
are those on which the dried excretions of
cholera patients are carried by draughts of air
into buildings and other places in contact with
A surgeon in India relates, that on one
jcasion after tiie existence of cholera in a pav-
icular district four European sal4w.t% >sb.<i 1mA
M, were attacked with cholera,
i thus attacked had their heds
i of two open doors which were op-
other in the hospital. The only
of this circumstance was to be
i fact, that the dust from the out-
i copiously blown in by a wind during
the night, and that this dust contained the
dried excretions of persons who had been known
to be attacked with cholera, and who had, after the
manner of people in the East, deposited their
excretions on the ground in contiguity with the
The poison of cholera may he easily" conveyed
by the hand to the mouth. Thus where atten-
dants are not cleanly al\er attending to the wants
of those diseased with cholera, and not careful
of washing, they may, by placing their fingers in
their moutliSj convey the poison to their mucous
membranes. Food taken by persons thus c
cumstanced may be poisoned, and produce the
disease. Even the affectionate embrnces of
relatives, when parting with dying friends, may
carry the poison of one mucous membrane to
another, and thus produce the disease.
But of all the means by which this poison
may be conveyed, that by water seems the most
constant and the most dangerous. 'I\iia mo&<
THE POIBOX OF CHOLERA.
of conveyance was bo novel, that when
suggested it was almost universally oppo;
Medical men had really no experience of
contagious diseases that could be conveyed
this way, and were incredulous as to the fa<
In the first epidemic, of which we had any
perience in this country, there were certain fact3
which led to the supposition that it might be
water that produced, in some way, a tendency to
this disease. It was especially in London that
this idea gained ground, aud an experiment,
on a vast scale, seemed to have been performed
on a district supplied by water from the Thames.
When the cholera prevailed in London in 1848,
the district of Lambeth was more afflicted in
proportion to its population than any district in
London. It was observed that this district was
supplied with water by companies that derived
their supply from below Battersea Bridge, and
consequently from a part of the Thames pecu-
liarly subject to contaminations from the sewers
which emptied themselves into this river. This
district was supplied by two companies, the
Lambeth and the Vauxhall, which delivered their
water throughout Lambeth in such a manoer,
that each company supplied the same streets,
and almost the same houses. At this time an
Act of Parliament was -jsasseA fcWKS^Xv»% *^'
33 tij£ Poison of Cholera.
water companies supplying London from the
Thames to draw their supplies beyond the in-
fluence of the tide from above Teddington Lock.
Between the years 1848 and 1854 the Lambeth
Company had opened its works beyond Teddiug--
ton Lock, whilst the Vauxhall Company i
still supplied from its old source. When the
cholera reappeared in 1854 it was found that the
houses which were served with the water supplied
by the Vauxhall Company suffered in the propor-
tion of seven to one compnred with those supplied
by the Lambeth Company. We think ther
no other explanation of this extraordinary fact,
than that the water of the river Thames b
Battersea was contaminated with the poison of
cholera, whilst that supplied from above Teil-
dington Lock was free from this influence,
give this instance as a proof that the poison from
the excretions of human beings may pass into
drains, and from drains into sewers, and from
sewers into rivers, and thus disperse the poise
to vast masses of a community.
That the same influence may be conveyed
from a water-closet to a well, is seen in the case
of the people attacked at Theyden-Bois, near
Epping ; hut the most gigantic case of this kind
which has ever appeared in the history of epi-
demic cholera, is that which occurred in the
THE POISON OF CHOLERA. S3
months of August and September, 18.5-1, in the
parish of St. James, Westminster. Tins case
demands attention, not only on account of its
completely demonstrating the fact that the
cholera poison may he conveyed by water, but
on account of its showing that of all sources of
unsuspected danger, the pump of a surface well
may be mont fatal and destructive in its influences.
In the parish of St. James, Westminster, is a street
in the district of Gold en -square, known by the
name of Broad-street. It is a wide street, and
healthy, because it is wider than the height of the
housesoneitherside. Inthisstreetstandsapump, .
an ordinary street pump, connected with a well
about 25 feet deep. The water percolates into
Ibis well through a loose gravel extending for
several hundreds of yards to its north and west.
All this gravel is covered with streets and
houses, and in it have been dug innumerable
cesspools, and through it pass numberless drains
— brick drains, rat-eaten, filthy, corrupt drains,
and also sewers — bad sewers — some of them in
the immediate neighbourhood of the pump ouly
half a brick thick. Such drains and such sewers
as only a country regardless of its health would
tolerate. This purap in the year 1S51 was a
piipular ptirop. From the soakoge i
secretions, and their oxidation in the loose gravel
THE rOISON OF CHOLERA.
the water was loaded with cooling salts and
boaic acid gas, formed from the oxidized carbi
human excretions, which made it lively to the
and pleasant to the taste. It was a popular pum]
just as the pump opposite St. Martin's chi
is popular at the present moment, because of
coolness and liveliness. At the latter end
August, 1S54, a case of diarrhoea occurred i;
house directly opposite the Broad-street pui
It was the case of a child — it was only diarrl
in a child ! No precautions were taken to
infect this child's evacuations. All its excretii
. were emptied into the closet, and there was
one to inquire where next they might pass,
the night of the 31st of August, there
weeping and lamentation in all that distri
The shadow of the angel of death had pas
over it. The authorities were paralysed, the po
lation was in dismay, lime was thrown on
roads, and black flags hung at each end of Broai
street. On the 1st of September tho Board
Guardians met to consult as to what ougl
be done. Of that meeting the late Dr. i
demanded an audience. He was admitted,
gave it a3 his opinion that the pump in Broad-
street, and the pump alone, was the cause of
all the pestilence. He was not believed — not a.
r of his own profession not an m&wV
THE TOIBON OF CHOLERA.
in the parish believed that Dr. Snow was right.
But the pump was closed, nevertheless, and the
jlagoe was stayed. Six weeks after, the vestry
of St. James, Westminster, appointed a com-
mittee to inquire into the origin of this sir
and terrible outbreak of cholera. It was calci
lated that upwards of 600 people, in a distri'
not numbering 4000 souls, bad died in three
days. The inquiries of this committee were con-
ducted with the greatest possiblo precision. Oi
it were several scientific men, and after three
months' investigation of tbe most careful and
accurate kind, they unanimously came to the
conclusion that the water of the Broad-street
pump was poisoned on the 31st of August, -and
that the outbreak of cholera in the district
Broad-street, Golden-square, depended satire];
on the poisoned nature of the water of that well.
The evidence adduced was most circumstnntii
and conclusive. It was shown that no conditio!
of tbe atmosphere or the soil or the localil
could in any way account for the outbreak of the
disease. It was also shown most conclusively,
by laborious personal investigation, that in a
large majority of the instances of persons at-
tacked or destroyed ly cholera that they bud drunk
of the water of this pump. Itwo.5. 8jw&sffl»ta!!k*&.
that, in a large factory iwfcdVj o^rtX»
Sfi THE POISON OF CHOLERA.
pump, the men who drank the water died of
disease, whilet thosu who did not were not
affected. The me,n who worked at a largo
brewery close to the pump, who never drank the
water, were none of them attacked. It was
shown by a map that the greater number of
those who died died in a circle round the pump
and had drunk the water on the 31st of August.
It was clearly demonstrated that certain persons
lying beyond the circle of the pump had been in
the habit of sending for the water of this pump
on account of its popular qualities. A manu-
facturer who lived near the pump was in the
habit of sending a quantity of the water every
day to his mother, who lived at West-end, Hamn-
stead. She died of cholera, and a niece also
who accidentally visited her and partook of the
water. The evidence was most full, complete,
and conclusive as to the relation of the disease
to the taking of the water. When all these facts
had been made out, the well was opened and
examined, and it was found that a direct com-
munication existed between the well and a cess-
pool in the house in which the first case of
cholera had occurred in the neighbourhood.*
* Report on the Outbreak of Cholera in the parish of
St. James, Westminster, in 1S51. London
THE POISON OF CHOLERA. 37
We now leave the question of Hie coutagiou:
ness of the disease ; there can he no doubt of ii
we think, after the evidence to which we havi
alluded. It is still an interesting point fo:
discussion as to whether the poison of cholera,
after it has passed from the human hody, lias
the power of increasing or multiplying so as to
widen by a- living action independent of the
human hody the sphere of its action. This
question must of courso at the present time he
problematical, seeing no one has succeeded
isolating and experimenting upon the poison.
Nevertheless there are some facts which euabh
lis to speculate with tolerable certainty on the
nature of this poison.
In the first place, then, it appears that the
poison retains its vitality for a long period of
time. An instance is related in Edinburgh
during the epidemic of 1848-9, that on its rt
currence in 1340 a woman was sent down to
receiving-house which had been shut up for
several months, for the purpose of cleansing it
and fitting it for the reception of fresh patients.
This woman, without any communication with
other cholera patients, came home from the
house she had been cleaning with sympti
cholera, and died in a few hours.
German writers record cases Vu -sdi\cV\ Md w«a
!S8 THE POISON OF CIIOLEliA.
ng i D
as though the poison-germs had tlio power of
multiplying anil growing when they came in
contact with certain kinds of Boil. Thus I
soil of cesspools null privies when thrown v.
the ground for agricultural and hoiiicultui
purposes, seems to hnve been peculiarly favour-
able to the growth and development of the
poison of cho?era. It seems as if the poison
might actually traverse the air, and alighting r-
theae appropriate beds like the spores of fungi i
theair.could reproduce themselves and agai
germs to the air. The occurrence of cholera i
London in 1818 and in 1&54 in the neighbour-
hood of grave-yards where the soil was recently
opened, and in streets which were opened for the
purpose of laying down gas or water pipes, led
many eminent physicians, amongst whom may
he named the late Dr. Ilodgkin, to suppose
that the poison of the cholera found in this kind
of soil a nidus on which it might develope itself
and be diffused through the air around.
The snmo theory has been proposed to account
for the contamination of water. It is supposed
that the quantity of poison passing from a
cholera patient into a well or a river, would be
so diluted that tiulcss it had the power of intilti-
I plication, it would be impossible to account for
the rapid and wide increase of the disease from
THE POISON OF CHOLERA.
the drinking of impregnated well and river water.
It may be as well to add that such a view as
this is not at all incompatible with the known
nature of the cells of the human body, of which
the poison probably consists. The poison cells
of small-pox are but changed cells of the same
nature as those found in the human blood, and
as no insurmountable objection exists to the
supposition that even these may grow, as well
as live out of the body, there is no reason why
we may not apply this view to the explanation
of certain of the phenomena of the communica-
tion of cholera.
THE CALCES OF THE
I CAUSES OF THE TENDENCY TO TAKE
Whatever may be the exciting cause of <
disease, whether it poison or some other exten.
agent, it will always be found that some pel
sons are more liable to take the disease tbf
others. This is called predisposition.
four men may le riding on the outside of u
coach on a cold day, two will contract inflam-
mation of the lungs, one will die, and the other
get well, but the other two will not be attacked
at all. The two first were predisposed to
take the disease; the one who died more pre-
disposed than the ODe who got well, but tho two
who did not take the disease were not predis
posed at all. So of two children exposed to tl
poison of small-pox, one will take it, the otht
not. On inquiry, we find that the one i
did not take the disease had been vaccini
The fact is, vaccination takes away the predis-
po&ii/va to take small-pox. The same fttm
TENDENCY TO TAKE CHOLERA. 41
exists with regard to all diseases. In districts
where cholera prevails, we find that it is only a
certain number of persons who take the disease.
This number varies in different localities.
Lamentable instances have occurred where
almost all the individuals living in a particular
locality have been seized, and other instances
occur where the disease is introduced aud only
a few individuals take the disease. The stronger
the predisposition to take the disease, the more
liable the person is to die; and instances are
constantly occurring in crowded neighbourhoods
where only one family is attacked, and every
member of this family will perish. It is there-
fore of considerable importance to ascertain
what are the conditions that favour the develop-
ment in the human body of a predisposition to
Now, there are four things which are more
especially necessary for the maintenance of the
body in good health, in a state in which it will
not be predisposed to take any disease. These
are, fresh air, pure water, good food, and warmth.
The deprivation of any one of these four may
engender a state of the system in which it will
be predisposed to take cholera, or any other
disease. We will now briefly ctlmbmib "Oft* c
ditions under which these &gen\& w& Q,A -
THE CAUSES OF THE
vidtmls, for the purpose' of showing how their
deficiency may iuvite the action of the poison
Freak Air. — An atmosphere composed of
nty-one ports by weight of oxygen, and
seventy-nine parts of nitrogen, is necessary to
the existence of every animal being ; alter these
proportions, and disease is the result. The pro-
visions for the maintenance of these properties
in our air are so perfect, that we seldom find
them disturbed, Even iu our overcrowded
towns the constituents of the atmosphere re-
main the same. It is not then in the changed
proportions of the grand constituents of the
atmosphere that we must look for an influence
on the system producing a predisposition to
disease, but in the quality of these constituents
and the presence of foreign substances. And
first, with regard to quality: it is now above
twenty years since, that Professor Schiinbein, of
Bale, announced the discovery of an agent in
the atmosphere, which he called ozone. This
substance is now known to be a changed or more
active condition of the oxygen gas of the atmo-
sphere, It possesses nil the active properties
of oxygen in a more intense degree, and its
:esence may be detected in the atmosphere by
ats on which it acta with \
TENDENCY TO TAKE CHOLERA.
activity than ordinary oxygen. Ozone is found
in the atmosphere in country districts, by the
sea-side, and on mountain -tops, more espe-
cially when the wind is blowing from the
south or west. Its action on the system is
highly favourable to health, and during its
absence the human body exhibits a predisposi-
tion to certain forms of disease. So evidently
is this the case, that certain writers have un-
hesitatingly referred a predisposition to take tbo
cholera poison to an absence of this agent.
During the prevalence of cholera in London in
18.18 and in 1854, a great deficiency of ozone
was observed, as indicated by the test papers
ordinarily employed for detecting this agent.
The same observations have been made in India.
Dr. Cook, who has reported on the subject of
" Ozono" to the government of Bombay,* states,
that on one occasion he was riding away from
the station of Ahuiednugger, having left his
wife residing there, and he was struck by the
slight influence the atmosphere was exerting on
the ozone test paper which he usually carried in
his hat. So important did he consider this
phenomenon, that he sent a messenger to warn
his wife, to request her to lease tioft -sJueSw,-^-
■ "Sanitary Notes," by 3. JVSa&S^Mfc 3°* T,ial **
/MdMm. September, 1866.
44 THE CACHES OF THE
In tliree days cholera broke out with greir
virulence, and raged in and around the canton
mcnt for some period. Now, it is not suggested
that the unozonised air conveys the cholera
poison with more facility, but that an atmo
sphere destitute of ozone renders the systei
more susceptible of the action of the choleraic
poison, that is, predisposeB the system to attacl
of cholera. There are many ways by which this
action could be explained, but we think it suffi-
cient to indicate the facts ns they have been given
by competent observers.
In the next place the air is subject to the
introduction of foreign agents, which exert
depressing influence on the system. Thus tin
atmosphere contains varying quantities of moii
turej and it has been found that both excessive
dryness and excessive moisture exert a depress-
ing influence on the system, and both conditions
have been recorded as favourable to attacks of
cholera. Over this and the foregoing agen
man has but little power when tlicy exist gene-
rally in the atmosphere of a district. It is ovei
the existence of what may be called foreign
agents that man has most influence.
Thus, carbonic acid is being constantly poured
into the atmosphere from the lungs of human
beings and other animals and from candles and
gas. Naturally this gas is speedily
TENDENCY TO TAKE CHOtERA.
throughout tho whole atmosphere; but when
human beings are kept in close rooms, and
even in close streets and alleys, this gas may
accumulate to nn extent to exert an injurious
and depressing effect upon tho system. Car-
bonic acid gas, which is formed in the blood
of all animals during the processes of life, is s
decidedly a poison that an animal prevented
from throwing it out from its luugs dies in the
course of three or four minutes, as seen in the
processes of bunging and drowning. Ono of the
great evils of our civilization is the crowding of
men and women into close rooms, where their
systems are constantly exposed to the action of
this gas. Persons thus situated are known to
become the subjects of scrofula and consump-
tion, two of the greatest scourges of civilized
litunnii beings. Thero can be no doubt that
where human beings are constantly exposed to
the action of this agent their system becomes
depressed, and they are predisposed to take tho
poison of cholera. It has always been in the
close, low, unventilcited buildings of our great
towns that cholera has prevailed to the greatest
extent. Such places do not generate cholera;
tbey offer a fitting means for the diffusion of
the poison, and it is in them that those persons
dwell whoso systems are mast s'
fiction of the poison o£ eVicAeia.
4G THE CADSE8 OF THE
The air of close and unventilated
also exposed to many exhalations from the
bodies of human beings, and from the various
things in the room. These matters are quite
impalpable; but they collect especially on the
glass windows of such rooms, and can he re-
vealed to the curious by the aid of the micro-
scope. They consist of cells of decaying animal
and vegetable matter, which frequently afford a
nidus for small living beings to live upon. Such
particles taken into the lungs interfere more or
leS9 with the absorption of oxygen into the
system, and have a tendency to produce those
changes in the vital organs which make the
system predisposed to yield to the action of the
poison of cholera, and to increase its influent
when once established.
All these facts with regard to the nature of the
influence of the atmosphere on the system point
to the necessity of cleanliness and ventilation.
2. Pure Water. — We have spoken of
agency of water in convoying the cholera poison,
hut quite independent of this action water may
exert an injurious effect upon the system, and
render it predisposed to attacks of cholera.
Water, as supplied to our towns, is seldom pure.
bit is derived principally from two sources, from
rivers and from wells. Under these circnm-
TENDENCY TO TAKE CHOLERA,
it is constantly impregnated with sail,
or mineral and organic matters. A few grai
of saline matters in the gallon of a
similar to those contained in the blood are not
injurious; but very small quantities of sub'
stances not contained in the body, as lend, will
act injuriously. A quantity of saline matter,
exceeding forty grains in tho gallon, shoult
render a water suspicious, and where purgati
salts ore found in water, as Epsom salts, Glaubi
salts, and others, there is no doubt their present
may lead to a state of the bowels which wouh
predispose to the reception and fatal activity
the cholera poison.
It is, however, the organic impurities of wai
that are most likely to act injuriously on
the system. They are derived from the decom-
position of anim al and vegetable substances, am
may be derived from living organis
matters introduced from the sewage of houi
Unfortunately, both our river and well waters
liable to this latter contamination. The qualit;
may be easily tested hy what is called the pi
mangannte test. A few drops of a solution
permanganate of potash (one grain
ounce) may be used for this purpose. If tl
permanganate loses its colour in the water ii
itains organic matters. An equal quauti
48 THE CAOSES OF THE
of water of known purity may be employed i
testing, and the difference in the colour of
two will indicate tlie amount of organic impurity
Water may be very bright when drawn and yet
be charged with a considerable quantity of 01
gauio matter. In the summer, when such wat<
contain less oxygen, they are liable to beco:
putrid, and on being taken, to irritate the boweli
and in tins way predispose persons to recei'
the poison of cholera.
In the summer especially, and at all seasoi
when cholera is prevailing, it is a safe plan
boil water, and when cold to pass it through a
filter before drinking it. The surface well*
pumps of Loudon are especially liable to con-
tamination, and on this account ought to he
avoided. Even in the country, away from
large towns, a practice exists of placing tho
cesspool witbin a few yards of the pump; aud
should any leakage take place from the former
to the latter the consequences to health may be
at all times disastrous, but when cholera prevails
may he fatal.
3. Good Food. — There is no proper nourish-
ment of the organs of the body without good
food ; and unless the organs are properly nou-
rished there will be no sound health, nod the
body will be predisposed to take disease. Cholera
TENDENCY TO TAKE CHOLERA. 49
is not like relapsing fever, a disease of famine,
hut where famine prevails in a district there
cholera will be most fatal. It is amongst the ill-
fed portions of our population that we find this
disease slaying the largest number of victims.
The question may be asked here as to what is
good food, so that this need may be supplied.
Food serves two purposes iu the system ; first, it
maintains the heat of the body, and secondly,
it renews the flesh that is wasted by the action
of the nerves and muscles. The first action is
produced by starch, sugar, and fat ; the second,
by albumen and fibrine, which are contained
in bread and the flesh of meat. In bread wo
have starch and fibrine, a heat-giver and
flesh-former. In butcher's meat we have fat
and fibrine, a heat-giver and flesh-former. In
vegetables we have certain mineral matters which
are also necessary for the nutrition of the body.
In all good food there should be these agents.
In addition to these kinds of food man takes
certain nervous stimulants with which ho flavours
the hot water which he finds necessary to take
into his system. These are tea, coffee, and
cocoa, A good breakfast consists of bread-and-
butter, bacon and eggs, and hot tea, coffee, or
cocoa. A good dinner consists of a slice of
meat, with bread and potatoes or other vege-
60 THB CAUSES OF THB
tables. A good sapper consists of bread.
milk, or bread and cheese, with coffeo or cocoa.
Of course this diet can be varied, and the sub-
stantinls cooked in a hundred different ways ;
but some people are at a loss to know what is
meant by good food, and think that unnecessary
luxuries should enter into its composition. Now,
it is not amongst those that live on the food we
have mentioned that predisposition to cholera is
produced. The food, however good, may be
deficient; and from this cause a feebleness of
the system is produced whioh invites attacks ol
The food amongst the lower classes is
of an improper kind and not fresh. When
kind of food predominates over another jt pro-
duces unfavourable results in the system. Thus
potatoes, when made a substantive article of diet,
as they contain too little nutritive matter, often
lay the foundation of predisposition to disease.
Disproportionate quantities of other vegetables,
as carrots, turnips, and potatoes, produce dis-
order of the bowels. On the Continent weak
soups are often taken by the poor people in
large quantities, and render them predisposed to
attacks of cholera. In Russia there is a taste
for taking these soups with ice, and people were
recently warned of the danger they ran. In
TENDENCY TO TAKE CHOLERA,
1832, Dr. Tytler pointed out that damaged [rice
eaten by the natives of India was a source of
predisposition to cholera, and he was inclined
to attribute the cholera in Europe to the use of
this damaged rice. Whether this was the case
or not, there is no doubt that food of any kind
in a state of decay is a source of derangement
to the bowels, and invites in the system attacks
of cholera. Numerous instances are recorded
in which persons have been attacked with cholt
soon after eating meat or fish which hi
way become tainted. Milk is very liable
become sour, which is the result of a change
which is highly prejudicial to health, and there
can be little doubt that a large amount of the
summer and autumu diarrhoea of this country,
which is often so fatal amongst children, is due
to the use of sour milk. Hence we comprehend
under the name of good food not only food that
is right in quality, but such as is sound
free from taint of any kind.
Under the head of food we must include bei
wines, and spirits. These alcoholic drinks
consumed extensively amongst the inhabitants
of Europe, and whilst there is no evidence to
show that the moderate and temperate taking
of these beverages is injurious to health, there
is abundant proof that the excessive indulgence
52 THE CAUSES OF THE
in them is one of the most fertile causes of
a predisposition to take cholera. It lias been
abundantly proved by the practice and expe-
rience of teetotallers that beer, wine, and spirits
nre not necessary to a healthy existence. There
is no evidence to show that persons who drink
nothing but water are more liable to cholera
than those who drink alcohol. It is true,
that where persons ore exposed to the drinking
of poisoned water, then those who drink nothing
hut water are more likely to be attacked than
those who drink nothing but beer or wine. It
appears that those who drink spirits and water
are equally exposed with teetotallers, as the
spirit does not appear to destroy the poison-
germs of cholera in water. Whilst raw spirits
act so injuriously on the coats of the stomach
that it may be questioned which is the most
dangerous poison, that of cholera water,
4. Warmth. — Even in our hottest summers
exposure of the person to cold will generate
disease. Instances of sudden attacks of cholera
have been known to take place by persons riding
for long distances on the outside of coaches, or
otherwise exposing themselves to cold. In the
autumn of the year when cholera has most fre-
quently visited this country, although the dayB
TENDENCY TO TAKE CHOLEEA. S3
are hot the nights are cold, and exposure to
the cold of night with insufficient clothing is
calculated to invite an attack of cholera when
the poison is present in any particular district.
It seems very important that the ahdornen should
be kept warm, hence the very general recom-
mendation of those who have seen an epidemic
of cholera that persons should wear during the
prevalence of cholera extra clothing, or at any
rate a flannel waistcoat.
5. Sex and Age. — The influence of sex and
age on the predisposition to cholera varies. It
is, however, very certain that persons of adult
age are more liable to the attacks of this disease
than children. During the present epidemic in
the east of London this has been observed. In
the week ending August 4th it was found that
there were 1003 cases of cholera; of these 457
cases occurred in children and 500 in adults.
In an attack of cholera experienced by our troops
in Canada, the following is the ratio pet 1000
of those who died ; —
From 18 to 25 . . . 15 in 1000.
„ 85 to 33 ... 23
„ 33 to 40 . . . 30 „
„ 40 to 50 . . . 70 „
54 THE CAUSES OF THE
towns that women ore more subject to tbi:
disease, or it is more ftttal to them than m<
Of 145 fatal cases in Sunderland, 63 were mail
nnd 82 were females.
It appears that the black and coloured raci
of mankind are more predisposed to take tl
cholera and to die with it than the whits
races. As far as returns go from various
parts of the world this is home out. In Hin-
dostan the natives are certainly much more
liable to the disease than the Europeans, and
suffer proportionately. The slave population
of South America, have always suffered very
severely when the disease has been introduced
The number of persons attacked by cholera
in a community has always varied very much,
and this has evidently depended on the amount
of energy and intelligence brought to bear on
the taking of means for its prevention. There
is undoubtedly a limit in every community
beyond which it cannot go. What that limit
it would he impossible to define ; but as with
other contagious diseases so with cholera, there
are some persons who have absolutely no pre-
disposition to take the disease. The reason
why these persons do not take the disease we
cannot say ; but they form the natural barrier
TENDENCY TO TAKE CHOLERA. 55
against which the waves of contagion surge in
vain. They constitute the means which Provi-
dence employs to prevent the destruction of the
whole human race by any plague.
A French writer gives the following table of
the number of persons attacked in the different
countries of Europe : —
France I in 300.
Russia 1 in 20.
Austria 1 in 30.
Prussia 1 in 100.
Belgium 1 in 120.
Great Britain . . . 1 in ISO.
Holland 1 in 14J.
Germany .... 1 in 700.
From the [foregoing remarks it will 1
that a variety of external causes act upon the
system, and engender in it a liability to take the
poison of cholera; hut these things must not be
regarded as the true cause of cholera. They
may exist in the utmost intensity, and will never
produce true epidemic cholera. This comes by
the agency of a poison which is brought to the
abodes of those who have not fresh air, pure
water, good food, or warm clothes. This poison,
in spite of the presence of all these agents of
health, will now and then smite down the
06 TENDENCY TO TAKE CHOLERA.
apparently healthy, the cared for, and the
wealthy ; hut it does not spread amongst them.
The doctor occasionally dies, the nurse is
smitten at her duties, the clergyman or the mis-
sionary are seized ; hut the disease does not
spread in their houses, where the poison is diluted
by abundance of fresh air, and all the appliances
that intelligence can employ are made use of.
HOW CHOLERA POISON IS CONVEYED.
In the preceding remarks we liave had to an-
ticipate much that might properly be said under
Uiis head. The great means hy which the
cholera poison is conveyed, are obviously the
air, water, and personal contact.
1. The Air. — The great means by which the
poison of scarlet fever, measles, typhus, and
small-pox are conveyed, is through the air. In
these cnses the disease affects the skin, and from
the surface of the skin the infecting poison i3
carried to the lungs through the air. The dif-
leruiii'o between cholera and these diseases is,
that the cholera affects the mucous memhr
of the alimentary canal, and the poison is there
produced. It is, therefore, much more likely to
be conveyed hy water, hut just as scarlet fever
poison may be carried by water though its
natural agent of diffusion is the air, so the
poison of cholera may be diffused through the
58 HOW CHOLERA POISON IS CONVEYED.
air. There is reason to believe that the poison 1
fumes of cholera may immediately escape into I
Um «ir from the evacuations, and the case o
persons taking the disease in carrying or washing
the linen of the diseased, or in attending upon
them, seem to indicate this fact. There are also
facts that seem to show that where cholera excre-
tions have been allowed to dry upon the soil, ex-
posod to the influence of the sun, that a draught
of air or breeze may blow the dried excretions of
the soil into the residences of human beings, and
thus communicate the disease.
It is, however, very questionable as to whether
the poison is of a nature to diffuse or propagate
itself in the air. We are greatly indebted to
Mr. Glaisher, of the Koyal Observatory, Green-
wich, for his careful observations on the meteoro-
logical conditions which accompany cholera
visitations, and be has lately described a "blue
mist" which he snw in 1W54, and which has
again appeared in 180(1. This observation is
very interesting, and if it were found that this
mist existed in greatest abundance when cholera
breaks out, and that it contained matters which
could in any way be made to produce cholera,
it would bo highly important. At present suf-
ficient is not known of this agency for us to be
BOW CHOLERA POISON IS CONVEYED. 59
able to pronounce that it has any connexion
with an outbreak of cholera.*
2. Water.— The cases referred to, when wa
were treating of the poison of cholera, are
sufficient to show that water is a more common
medium for the diffusion of the cholera poison
than air ; and we see how this^swheu we consider
that the contents of the bowels naturally come
in contact with water in the soils orrivers where
they find their destination. This fact is of the
almost importance, as it alone explains the
cause of those sudden, irresistible, and devas-
tating outbreaks which occur iu the midst of
the cities of Europe. To say nothing of the
present outbreak iu the east of London and of
others in many parts of England and the con-
tinent of Europe, let us once more draw atten-
tion to the two great typical cases — the out-
breaks in Lambeth in 1848 and 185-1, and
the outbreak in Broad-street, Golden-square, iu
1854. Both these causes are so conclusive as
to the water of the Thames and the water of
the Broad-street pump causing the cholera, that
no other theory is at all tenable. The water of
the Thames which supplied Lambeth was e
posed to cholera evacuations from the drai
• Sec Appendix A.
60 HOW CHOLERA POISON IS CONVEYED.
and sewers of London ; the water of the Broad-
street pump was exposed to the contents of a
cesspool in a house where a person had been
attacked with cholera.*
The practical lesson to be derived from this
knowledge is the fact that no community is safe
from cholera that ii dependent for its supply of
drinking-water on rivers receiving sewage, or
on wells that may communicate with drains,
cesspools, or water-closetB. Now, this is an
alarming statement, but it must be looked in
the face. A question here arises as to whether
it is so far possible to dilute the poison of
cholera as to render it comparatively innocuous.
Reasoning by aualogy, we may suppose that
cholera poison may be diluted in the water just
as typhus fever poison is diluted in the air. We
know that a typhus fever patient may be so
placed that the poison which escapes from his
body shall be so thoroughly diffused that it will
not attack another person. Now this is possible
with the cholera poison ; and it may be that
even should Reading or Oxford suffer from
cholera that the poison of their sewers will not
reach London. There is even good grounds
Report on (he Cholera Outbreak iu St. James,
estminstcr, 1854." Churchill.
the Communication, of Cholera." Ej John Snow,
for believing that it would not. Water when
exposed to the air absorbs oxygen, and always
contains considerable quantities of this gas.
Now, as long as the organic matters are not in
overpowering quantity, it is the property of this
gas to oxidize these matters, to destroy their
putridity, and to prevent their becoming inju-
rious to man. It is from this cause that river-
waters, which receive considerable quantities of
sewage matter, have been found free from or-
It is not, however, well that people should
depend on such an agency for the purification
of those rivers from which drinking-water is
I derived, and where there is the least suspicion
of the conveyance of so dreadful a poison as
that of cholera every precaution Bhould be taken.
It is well known that most animal poisons are
destroyed at the temperature of boiling water,
and this offers a BJmple means of rendering un-
injurious any suspected water. A more effectual
way of purifyiug water has been recently and
strongly recommended by Professor Frankland,
and that is, of passing it through animal charcoal.
If water then is first boiled, and then filtered
through a filter composed of animal charcoal,
it may be taken with impunity.
3. Contact. — There can be no doubt that
amongst those who are habitualVj ■ns$\^&. <A
HOW CHOLERA POISON IS CONVEYED.
62 HOW CHOLERA POISON IS CONVEYED.
personal cleanliness, direct contact with the
poison from the mucous membranes of such
persons is a constant means of communicating
the disease. Persons attending upon the sick
perform for them offices which must necessarily
bring their hands in contact with the poison ;
and if they are not careful to wash and use dis-
infectants, they may easily by taking food, or
by other means convey their hands to their
mouths, and thus swallow enough of the poison
to render them liable to an attack of the disease.
This leads us to observe how thoroughly neces-
sary is absolute cleanliness. It is the cleanli-
ness of those who nurse and attend upon the
sick in our great hospitals that spares them from
the attacks that so often fall upon those who are
careless of their persons and ignorant of the
laws of this disease.
BOW TO PREVENT CHOLERA.
The preaeding chapters have been written with
the view of giving information to the public on
the nature of cholera, under the conviction that
it ia only by an intelligent apprehension of the
laws which govern the development of this dis-
ease on the part of the great bulk of the com-
munity, that we can ever hope to proveut its
appearance or arrest its progress when it has
appeared. It must, thou, ho very evident that
there are two things, or sets of things, to be
done : — 1. To secure for ourselves and our
neighbours such a state of bodily health that wo
may not be predisposed to take the disease.
2. To take all possible precautions against tho
introduction of the poison of cholora.
With regard to the first object to bo attained
it has this advantage, that what is good against
cholera is good against almost all other form3 of
One of the most essential things
CI HOW TO PREVENT CHOLKKA.
health is fresh air — air unadulterated with rar
neral, vegetable, or animal impurities. It may
not be possible for every one to obtain perfectly
pure air, but every effort should be made to do
so, and every one should reflect that ceteris pari-
bus, the person who breathes the most fresh air
will live the longest. All persons engaged in
sedentary pursuits should strive to obtain fully
two to three hours' exercise in the open air every
day. Not only is the air beneficial, but the ex-
orcise also. The heart, the lungs, the muscles,
the stomach, the bowels are nil benefited by
exercise in the open air. The air of the closest
streets and courts in London is better than the
air of close and ill- ventilated rooms.
Next to exercise in the open air, the venti-
lation of sitting-rooms, bed-rooms, workshops,
schools, chapels, churches, places of amusement,
should be attended to. In tbis operation two
things should be regarded, — first, the getting
rid of the bad air, the carbonic acid gas, and
other impurities from within; and second, the
letting in of fresh air containing oxygen from
tcithout. Fires ventilate rooms in cold weather
by drawing the air of the room up the chimney,
and thus allowing air to come in from without.
But all Tooms without fires should be ventilated
hy letting down the top sash, of the window, or
HOW TO PREVENT CHOLERA.
ventilating panes in the windows or -valves in
the chimneys. All these arrangements should he
made so ns not to expose individuals to a draught
of cold nir. A draught is occasionally unavoid-
able for the purpose of ventilation, hut the want
of fresh air is the greater evil of the two.
The overcrowding of rooms should be avoided.
In either sitting-rooms or bed-rooms wjiero
there are lens than 500 cubic feet of space to
each individual, the room may he regarded as
overcrowded- It is in the overcrowded rooms oF
the poor of London that cholera and other dis-
eases find the largest number of victims.
In order that the air of a room may he fresh
everything in it should be clean. Dirty walls, dirty
floors, dirty carpets, dirty beds, dirty curtains,
dirty clothes, and dirty skins, all contaminate
the air and render it unfit to breathe. A room
should have no smell, and directly any un-
pleasant smell arise its source should be dis-
covered and removed. Dwelling-rooms should
be whitewashed at least once in the year, and
oftener when obviously dirty. The floors of
rooms and stairs should he scrubbed onci
week. Hugs and mats should he beaten every
two or three days. Better to have no carpets
than dirty ones. Bed-ciirl.ains should be dis
pensed with. They are a nuisance when clean.
CO HOW TO PREVENT CHOLERA.
and n source of disease when dirty. Bed-
should be changed once a fortnight, and bed
steads taken down and cleansed ouce a year at
least. Dirty slops should bo at once emptied
Personal cleanliness should be secured by
washing and bathing. Children should be
washed at home from head to foot at least once
or twice a week. Grown-up persons, male and
female, should bathe frequently. In all our
large towns there are baths which can be made
use of at a low price by the poor.
Bad smells may arise from many sources out-
side the room, and should he looked after.
Dust-bius or ash-pits arc receptacles neces-
sary for the cleanliness of the bouse, but
they never ought to smell. They should be
emptied at least once a week. They frequently
smell on account of the lazy habit of servants
and housekeepers of throwing in with the cinders
and other dry dust vegetable and animal refuse.
All such things, if not otherwise made use of,
should be thrown on to the fire. In all our
large towns there are dustmen, who are com-
pelled to remove the dust whenever called upon
to do so.
In all cases water-closets should havo a con-
stant supply of water. It should be rememherei
HOW TO Pit EVENT CHOLERA. 07
that every closet which lets water down to a drain
may allow bad air to come back, so that the traps
should be looked to regularly and kept well
charged with water. Privies should be placed
at some distance from the house, and the seat
should be constantly covered and ventilation
secured through the door. When contagious
diseases of any kind exist in the house, some
form of disinfectant should be thrown down
every day. Cesspools should not he emptied in
The drains of houses should be constam
looked to, as when improperly constructed or
not trapped, they may allow dangerous emani
tions to escape into the bouse.
Oil''. 1 ii si ve businesses in crowded neighbour-
hoods, such as the keeping of cows, horses,
pigs, poultry, or other animals, the slaughtering
of animals, the boiling or storing of grease or
other animal matter, are all liable to indictment,
and when such businesses are productive of bad
smells and injuro health, they should be got
All these sources of bad smells and inji
to health may be dealt with by law. It
the duty of the landlord, with regard to the
great mass of the bouses occupied by the poor
of England, to attend to the cleaning of
08 HOW TO PELVEST CHOLERA.
house, and the state of the drains and
water-closets. Wherever the local authorities are
called upon to net, they should take perms
iioder tho " Nuisances Removal Act," which is
not only operative for London and the largo
towns of England, but for the country. Many
of the evils arising from these causes which ex-
pose the populations of our small towns and
villages to attacks of cholera are removable by
tho application of this Act. The "Sanitary
Act of 1BC0" is more stringent still, and gives
great powers to local authorities for the removal
of all nuisances productive of disease. It is to
he hoped that medical men, clergymen, and the
wealthy inhabitants of our rural districts will
feel that the health and lives of a large number
of their fellow- creatures are dependent on their
public spirit, patriotism, and Christian charity,
in carrying out Acts of Parliament which have
been passed to cure evils which deeply oppress
and injure the poor population of this country.
We next come to water, and on this subject
so much has been said that it can only bo neces-
sary to repeat here, that one great means of
maintaining the health of a community is the sup-
ply of pure water. It is, however, not only neces-
sary to have a source of pure water, but as in
many cases thi3 water has to bo stored, it
HOW TO l'REVENT CHOLE]
necessary to look to the storage. It would be
better if this could be done by the water company
and the water supplied constantly, but at present
this is out of the question, and one thing we
ought all to do is to look to our cisterns and
water- butts. Cisterns and water-butts are too
often neglected. They aro frequently situated
where the effluvia from water-closets and dust-
bins pass directly into them, and the water is
thus contaminated with sewer gnses. They
should always be covered, and at this*season of
the year should he emptied and washed out at
least once a mouth. Quicklime should be used
to cleanse the bottom, and wooden butts should
be fresh pitched at least once a year. Where
water is liable to contamination permanganate
of potash may he added till it begins to tinge
the water. The permanganate effectually <
st.roys organic matter.
Wo have before spoken of the importance of
boiling aud filtering water before drinking it in
seasons of epidemic cholera. It is not often
that poor people can buy filters, the demand for
tliem is not yet great enough to induce the
earthenware manufacturer to produce a cheap
one. In the absence of one ready made,
filter can be extemporized by taking a pail c
icket, placing it over two pieces of ,
70 HOW TO FREVEST CHOLERA.
then standing over it a common flowei
The hole Rt the bottom of the flower-pot should
bo plugged with sponge, and then into the bottom
is to be placed a layer of animal charcoal, not
in fine powder, but in large graics like OMUH
salt or gunpowder. Over the- chare
to bo laid a layer of sand nnd pebbles to keep it
down, and water poured into it and allowed to
filter through into the pail below.*
We now come to the question of how to pre-
vent the introduction of the cholera poison into
a country, a town, or a house. With regard to
a country, this can only be done by the actiou
of the Government, and by quarantine lawa.
There has been so much oppression carried on,
by the Governments of Europe through quaran-
tine laws, that liberal politicians have been
nnxious to diminish their severity, and have
hesitated to introduce new ones. Our own
Government has in particular been tardy to
enforce any restrictions on the commerce of this
country for the sake of preventing cholera.
Hence it has found its way to our own seaport
towns almost as soon as possible. Tims it was
* Such a Alter was to be seen fa the food collection at
the South. Kensington Museum when that institution was
conducted with the object of inttnteting the people ia
what concerns their daily welfare.
HOW TO PREVENT CHOLERA.
at Southampton and Liverpool in 18G5, and hat
probably thus found its way to London in 18
When once the poison has found its way into a
country it is most difficult, to check its progi
by quarantine. Nevertheless, every reasonable
precaution should he taken. The Legislature
lms in fact provided for extra powers being given
to local authorities when an outbreak of cholera
is anticipated. The following instructions have
been recently issued by tlie l'rivy Council :-
When Cholera is in a Parish or Districl.
. . Every vestry or board shall make arrange-
ments for meeting, where the disease is actuall;
prevailing, daily, either in a body or in one t
more committees, according to the exigencies o
the parish or district, for the purpose of exercising
the powers conferred upon them by the Act.
2. The meetings may ba held at the ordini
hoard-room, and where necessary at such otbei
places as shall appear to be most convenient for
dealing with the disease, and the vestry or board
shall cause proper minutes of all proceedings t
be made and duly recorded.
3. The medical officer of health shall, as far
as practicable, attend the meetings of the v
or board, and of its committees, to render 1
advice thereat, and shall s^ermi
72 HOW TO TREVENT CHOLERA.
medical nrrangements fur preventing and Irei
ing the disease.
4. Ill each parish or district in which clioli
is preBeiit, or, if the quantity of work to
renders it desirable to subdivide the parish or
district, then in each of such suh divisions, a
legally qualified medical practitioner shall
put in charge of the parish, or district, or sul
division for the medical purposes of these re;
lations; and to each such medical practilioi
(hereinafter named the medical visitor) shall
allotted such assistants as the vestry or hoi
Such medical visitor, where practicable, or
other cases one of his assistants, shall at 1c
onco daily visit those places assigned to hi
which are inhabited by the poorer classes ai
wherein the disease is, and shall there inqnire at
every house as to the existence of diarrhoea or
cholera, and shall enter in a book to he kept ft
the purpose the facts as to all cases he may mei
with, and shall without delay give, or take tl
proper steps for causing to he given, all neces
sary medical assistance to the sick. And the
medical visitor or assistant shall, when visiting
the places assigned to him, be provided
medicines for immediate administration in urgei
md shall be held to be in medical chi
HOW TO PREVENT CHOLERA.
0/ all cases of diarrhoea or cholera with which lie
may meet until he is relieved by such other
provision for their medical attendance as may be
made or sanctioned by the vestry or board.
5. Such medical visitor shall, by transmitting
his above required book, or otherwise, report
daily to the medical officer of health the result
of his own and his assistants' inquiries, and shall
report any nuisances which ho or they find exist-
ing in any premises visited by him or them, and
shall make such suggestions as to the state of
the parish or district as he shall deem advisable.
0. The visitors shall, where they find it expe-
dient, communicate to the relieving officer of the
district any case of destitution requiring relief,
which is not entered in his relief list ; and such
officer shall forthwith visit the same, and give
such relief as in bis judgment the case shi
7. The vestry or board shall provide a suf-
ficient number of dispensaries, to be open night
and day, at convenient places within their parish
or district, with an adequate supply of audi
medicines, medical appliances and disinfectanl
as their medical officer of health shall
mend, and with a legally qualified medical prac-
titioner or skilled assistant always iu attendance
; each; and such medicines, m.ei\ta.\. w^jK.-
HOW TO TREVENT CHOLERA.
ances and disinfectants, shall be dispensed wii
out charge by such medical practitioner
assistant to persons bringing orders for the sai
from the medical visitors, and to other persons
who apply for immediate medical treatment.
And the names and addresses of all such appli-
cants shall be sent to the medical visitor of tl
place in which they reside.
8. In every case of cholera or diarrhcea, vth
the patient is not under medical care and ti
ment, the vestry or board shall cause medii
assistance to be rendered with the utmost ex]
dition, and such aid and comfort, nourishmei
and accommodation, as the circumstances oft!
case will admit, with the object of restor
'.). The vestry or board shall provide c
pctent nurses to aid every medical visitor in
attendance upon the patients suffering from
1(1. When the medical officer of health
commends, the vestry or hoard shall, with
much despatch as practicable, provide fit and
proper accommodation for the reception of such
patients as have no home, or cannot properly he
treated at home, and may with advantage
themselves be removed, -and shall cause the sai
i be provided with all appliances, medicim
HOW TO PREVENT CHOLERA. 75
furniture, and other things necessary for the
emergency, aud shall Appoint a legally qualified
medical practitioner, with or without assistant,
as the case may require, to attend to the same.
11. If cholera or choleraic diarrhoea exist in
any Swelling whereof the medical officer of
health reports that the sick and healthy cannot
therein he properly separated, the vestry or
hoard shall forthwith cause adequate accommo-
dation to he procured for the reception of tho
healthy; and, when the medical officer of health
recommends that the sick person shall not he
removed, hat that the healthy shall he removed
from the same room in which the sick person is
lying, the vestry or hoard shall cause tho other
inmates of such room to he removed to some
convenient place of reception.
12. Tho vestry or hoard shall, in dwellings
where cholera or diarrhoea exists, cause proper
disinfectants tu bo used in sufficient quantities
for the purposo of disinfecting the discharges
from tho sick, and tho bedding, clothing, and
other things thereby infirted, and the utensils
and privies in which such discharges may have
13. The vestry or board shall cause every
article of elothiug, bedding, or furniture which
shall have been infected vsitii rav-j sm^u K\%fiftas^
70 HOW TO TEEVENT CHOLERA.
and which they shall find incapable of bei:
speedily disinfected, to be forthwith destroyi
the vestry or board within a reasonable time
placing all such articles, or paying the reasi
able value to the owner.
U. If it be shown to the vestry or boarct tl
any drinking-water used in their parish or di:
trict is polluted, they shall take measures, wM
as much expedition as possible, for procurinj
wholesome water to be supplied in its stead, so
far as the case requires, to the inmates of the
houses in their parish or district, and for pre-
venting, as far as possible, the further use of the
polluted water. And every vestry or board
owning or having possession of any waterworks
for the supply of water shall cause the reservoirs,
cisterns, pipes, pumps, and other apparatus he
longing thereto, to be carefully examinei
cleansed and purified, and other necessary mei
Bures to be taken, so that tlio water may
supplied without impurity.
15. The vestry or board shall make due
rangements with undertakers, and with thi
proper authorities of the churchyards,
grounds, and cemeteries of their parish or di:
trict, so that coffins may bo ready to be supplied
immediately on demand, and interments speedily
take place in the cases of deaths arising from
HOW TO PREVENT cholera. 77
cholera or diarrhoea ; and the ve9try or board
shall, when informed of any such death, cause
the corpse to be buried with the earliest possible
16. Where any death shall occur from cholera
or choleraic diarrhoea, no collection of persons
shall assemble in the room where the corpse is,
and no " waking" of the dead shall be allowed.
17. The vestry or board shall cause the im-
mediate removal, from any room which living
persons inhabit, of the corpse of every person
dying, from cholera or choleraic diarrhoea, until
the time of its interment, and shall cause such
means to be adopted % for preventing the spread
of infection from the corpse as their medical
officer of health shall recommend.
18. If the vestry or board shall be informed
that cholera or choleraic diarrhoea exists, or
within three days previously has existed, in any
ship or vessel which may be lying within their
parish or district, they shall cause the same to
be forthwith visited, inspected, and otherwise
dealt with, according to the circumstances of the
case, in like manner as if it were an inhabited
house on shore, and shall give all such medical
and other directions in reference to the persons
in such vessel or ship, as shall be requisite for
preventing the spread of the disease, and for the
78 HOW TO PREVENT CHOLERA.
disinfection or disposal of any things which may
be infected or may have been exposed to infec-
tion, subject always to the provisions of any
Order of Council issued under the Quarantine
Laws for the time being in force in such parish
These directions embrace almost all that is
possible to be done by a community anticipating
an invasion of cholera.
WHAT TO DO WHEN CHOLERA BREAKS OCT.
Supposing all precautions to fail, and a case or
cases of cholera occur in a house — what is to be
done ? Now, we need not say that a medical
man should he sent for at once, and that to him
should be entrusted the management of all
matters relating to the sick person and the pre-
servation of the family from its further spread.
But, as in all cases much precious time may he
lost in waiting for the medical man, and persons
may he placed in situations where a medical
man cannot he had, we shall here say a few words
with regard to action where cholera breaks out.
In the first place, then, we would say that when
cholera is about, every case of ordiuary diarrhoea,
or looseness of the bowels, should be treated as
a case of cholera. All cholera is attended with
a premonitory diorrhcea, which in that stage is
not distinguishable from an ordinary purging.
Whenever, therefore, purging commenc
individual he should regard himself as sick,
80 WHAT TO DO
such persons should, if possible, forego their usual
occupations, and keep in hed. They should be
covered up warm, and some medicine containing
a small quantity of Opium should be given them
at ouce. This dose should be repeated after
every liquid evacuation. It would be well for
persons to keep in the house a diarrhoea mix-
ture. The following is a good one : —
Laudanum 5 drops.
Compound Tincture of Catechu . 30 drops.
Cajuput Oil 1 drop.
Chalk Mixture Jan ounce.
If the mixture cannot be easily obtained, five
drops of laudanum in half a wineglassful of pep-
permint water or weak brandy- and- water should
It is unnecessary to multiply prescriptions for
popular use ; but should any one possess any of
the preparations of opium of the British phar-
macopoeia, they should remember that about the
third of a grain of opium may be given after
every liquid evacuation. The dose should be less
for children. Half the dose for an adult should
bo given to children under ten years of age, and
from a drop to two drops of laudanum for children
under five years of age. It should, however, be
recollected that domestic treatment is always
WHEN CHOLERA I1REAKS OUT.
hazardous, and nothing can substitute the eyi
of the experienced medical practitioner.
With regard to diet, it should consist inainb
of slops ; of beef-tea, broth, gruel, or rl
Caution should be used with regard to t"
administration of stimulants. Whilst
brand y-and- water may he of great ;
saccharine wines and beers, by produeii
acidity on the stomach, may do great harm.
When good brandy cannot he obtained, the best
substitute is Scotch or Irish whisky.
If, unfortunately, no medical aid should be at
hand and the stools become colourless and watery,
assuming the character known by the
"rice-water," and vomiting should increase, am
coldness and hlueness come on, the opium shouli
be discontinued and ardent spirits avoided.
The patient should be allowed to drink col
water freely, and should he abundantly su;
plied with fresh air. He should lie in bed and
warm applications he made to the feet and legs,
nnd a mustard poultice or a pledget of linen
dipped in turpentine should be applied to the
stomach. The ports affected with cramps should
he rubbed with the warm hand. It is efficient
nursing, and not medicine, that does most good
in this stage.
Thus much with regard to fee VtefltaassA
82 WHAT TO HO WHEN CHOLERA BBEAKS ODT.
the patient, we now come to the question of
what is to be done outside the patient, and one
of the first things to be attended to here is the
prevention of the spread of the cholera poison.
Everything that the patient has worn, his night-
dress and the sheets on which he lies, nnd the
bedding and bed- furniture should be looked
upon as capable of spreading the disease, and
Bhould he disinfected or destroyed. The safer
way is, undoubtedly, to destroy by fire all soiled
linen and clothes. Other things should be im-
mediately disinfected and then plunged in boil-
ing water. All that passes from the sick should
be looked upon as highly poisonous, and should
first be disinfected and then got rid of at once.
Every sink, and vessel, and cloth, or article of
bedding or clothing that have touched either the
vomit or the stools should he disinfected. The
closets or drains into which they are thrown
should he constantly treated with some form or
other of the various commonly used disinfectants.
Those who die of cholera should as speedily as
possible be placed in their coffins and buried.
At the bottom of the coffin should be placed a
layer three or four inches deep of charcoal.
The body should he sprinkled with a solution of
some permanganate-, and a layer, of charcoal
should be put on the top of the body and the lid
screwed down immediately, ,
Ol'R essay would be incomplete without a few
words on the nature of those substances which
have been so often recommended under the name
of "Disinfectants." Deodoriser is another term
applied to the same set of substances. They
are undoubtedly useful auxiliaries. When con-
tagious diseases however break out, it should
always he recollected that they are no substi-
tutes for cleanliness and ventilation. In fact, if
no other precautions are employed, they may he
worse than useless as leading to a confidence
which the experience of their employment
does not justify. It ia not always when bac
smells are removed hy their agency that 1
poison of disease has been destroyed.
Disinfectants act in two ways; — first, by pre-
venting the diffusion of poisons; and secondly,
by destroying these poisons. Thus we find that
extreme cold and extreme heat act unoa wamA
poisons in these ways. "Extreme cAi. -^ws"*«o^
84 OX niSINFECTANTS.
poisons from being diffused and oxidized, whilst
extreme heat destroys the chemical structure
the poison, nnd assists tho action of oxygen.
It is in this way we may account for the arrest
of contagious diseases by the existence of ex-
tremes of atmospheric heat and cold.
The agents which act in the same way as cold
are carbolic acid, kreasote, camphor, must, al-
cohol, and other chemical agents. Of these
only one is generally available for disinfecting
purposes during cholera, and that is carbolic
acid. This acid can be obtained pure and
added to water; one part of acid to fifty of
water may he applied as a solution for washing
out drains and sinks, and yards, and a stronger
solution may be used for mixing with cholera
evacuations, and rinsing out chamber- utensils
and other vessels infected with the evacuations.
Carbolic acid is also used in conjunction with
lime and other agents, and may thus be used in
a Bolid form. This acid forms the principal in
McDougall's disinfecting powder, which is sold
in sealed bottles with holes over the mouth, so
as to admit the powder being dusted about in
the same mauner as pepper from a pepper-
There is another acid having the same pro^
pertiea &s carbolic acid, o*He4 acrylic
This acid, combined with lime aad other agents,
is sold under the name of Calvert's Carbolic
Acid Powder, in tin cases with holes at the top.
This powder is sold wholesale nt 15s. per cwt,,
or Gl. a ton.
These powders may he used advantageously
for disinfecting large spaces, such as drains and
sewers, where men are working at removing the
soil from cesspools and drains, coach-houses,
Those agents which act by destroying animal
and vegetable poisons are extreme heat,
chlorine, ozone, permanganates of potash or
soda, nitrous acid, sulphurous acid, iodine, bro-
mine. Of these, the most available are heat,
chlorine and ozone. It has been shown by ex-
periment that a temperature equal to that of
boiling water will destroy the poison of certain
infectious diseases. As boiling water is easily
procured in most households, a sufficient quan-
tity should he ready, in which to plunge
garments and linen which have been soiled by
the person sick of cholera. This can be done
after they have been removed from the
the patient, when they have been heated with
some other disinfectant.
Chlorine is perhaps the most active oC
disinfectants. The best^&N, to Hg^Tk^
86 ON DISINFECTANTS.
infecting the air, is to use it aa gas. The v
ready way of manufacturing it is to take
Common salt, 4 parts,
Peroxide of manganese, 1 part,
Sulphuric acid (oil of vitriol) and water,
of each 2 parts.
Mix the salt and peroxide, and put them ini
a basin, and then put in the oil of vitriol, and
afterwards the water. This may be placed in
some convenient part of the room to he disin-
fected, caro being taken not to mix too large a
quantity for the room, and to avoid directly
breathing the purs chloride.
When persons have not sufficient confidence
in their chemistry to use the above, " chloride of
lime," as it is called, may he employed, whicl
when placed in water slowly evolves chlorii
and is a very manageable substance.
Ozone is an active form of oxygen gas.
Oxygen i3 nature's great disinfectant. The
world is kept from putridity and death by oxygon.
At the same time ozune is not easily manufac-
tured pure for disinfecting purposes, but in per-
manganic acid we have a large quantity of
ozone, which is readily given off when it comes
in contact with organic matters. This acid
forms permanganates which are e&aiVj mwiuW-
tured, and a solution of them is now w>W is
ON DISINFECTANTS. 87
the shops under tlie name of Condy's disinfect-
ing fluid. The permanganates speedily give out
their ozone and become a ready means of disin-
fection. Condy's fluid is well adapted for dis
infecting liquids of all kinds, also for floors,
furniture, and clothes; but tho ozone is not
given off from this preparation into the
Hence it is useless to employ it for diffusii
We have before alluded to water containing
oxygen, and it is in this way that water itself
may become a disinfectant. It can, however, only
he where water is free from organic matter that
it acts thus. It is where water is charged with
organic matter that it conveys the poison
cholera; and, unfortunately, this is often tl
case with our rivers and wells.
There are many other disinfectants or deodo-
risers, but those we have mentioned above are
tbo best known and most readily accessible.
The following demand, however, attention, and
may he used when found convenient, *
Chloride of zinc is the basis of "Burnett's
Fluid." It has the power of destroying amino-
niacal compounds and organic matter, and thus
acts as a disinfectant.
Perchloride of iron has the power of destro^-
ig sulphuretted hydrogen, and thus of deo<
rising the decoying compounds to which it
Iodine is an expensive deodorising agent,
is said to be very efficacious. It decompost
sulphuretted hydrogen and arrests putrefucti
It is best used by exposing pure iodine in
room upon a hot plate.
Nitrons acid is a powerful deodoriser and dis-
infectant. It can easily be produced by putting
a piece of copper into nitric acid, when red fumes
are produced which are nitrous acid.
Sulphurous acid, which is evolved win
sulphur is burned in the open air, has bi
strongly recommended as a disinfectant, but
fumes are very stifling and oppressive.
We have now finished the task
selves on commencing this little work. Oi
object has been to indicate the nature of the
terrible disease which has now for the fourth
time visited our country. We feel convinced
that when once the causes and means of pi
venting this disease are fully understood
the great bulk of the community it will bo di:
armed of its terrors and deprived of its power
destroying life. It is one of those visitations
Providence that result from the ignorant brcaki
ri ON DISINFECTANTS. 81*
of those laws by which the lives of human beings
are governed. At this moment we have to deal
with its awful presence, but we may hope by in-
telligent fiction, and Christian courage, that its
stay amongst ns may be of brief duration.
Our future freedom from its dreaded visitations
must be looked for in the improved health and
intelligence of our poorer classes. This object
can only be obtained by the educntion of the
great mass of the people. We need in our
universities, our high schools and middle-
class schools, our Sunday-schools and ragged
schools, a larger teaching of those laws of life
on which the health of the people depends.
"My people perish, and there is none to con-
sider," was the divine complaint of old, and
surely it is most appropriate now ! We are
surrounded by tbo sources of disease and death,
" Surely the curse causeless will not come ;"
and if we have in these remarks shown that our
present affliction has arisen from causes over
which man holds almost supreme control,
we ought to have done enough to awaken in
every intelligent mind a sense of the duty of
earnestly studying the nature of those causes
the removal of which the Almighty Disposer
of events has so evidently placed within out
REMARKS ON THE "BLUE MIST" OBSERV
BY MR. GLAiSUER.
By E. Ray LankesteRj Esq., of Christcluich,
It was suggested by Mr. Glnislier that it would
be desirable to make an examination of the I
mist noticed by him, by means of the mioroscope,
and accordingly the following means were used
for obtaining any particles which might ho pre-
sent in the air in order to examine them
Slips of glass were cleaned and exposed under
trees where the blue mist was observable. Sit
A pane of window-glass was cleaned and t
posed to the mist for ten days, at Hampstead ;
the translucent film which had collected on it
was removed with pure boiled -water and a clean
brush. 3rd. A pair of bellows, carefully cleaned,
was made to blow the " mist" for half an hour
rough n small bottle of perfectly pure water,
The sediment from the water and the slips of
glass were at once examined ; besides a few
iusect'Scales and dust grains — in all, three cases
— a great abundance of minute granular aggre-
gations was seen, the largest of the granules
exceeding l-6000th of an inch in diamt
The granules were highly refractive, and pr<
sented all the characters of fungoid growths,
being similar to the spores of the yeast plant
and other moulds. The abundance of these
spherical granules, sometimes grouped iu chain!
was very noticeable.
In a paper read by Mr. Jabez Hogg to tin
Microscopical Society of London, I find thai
during the cholera visitation of 1854, the Rev.
Lord Godolphin Osborne obtained these fung
spores from the neighbourhood of cesspools,
gullylioles, &.c, and termed them " atrozoa.'
Mr. Hogg has himself observed them ever
that time in all places and at all seasons
remarks that there is no doubt that at the em
of hot weather, and in the autumn time, tin
are most abundant.
There is no evidence whatever that the fungus
spores noticed in the blue mist are peculiar in
their nature, or connected in any wa^ vriilt
lolera. The only tVvmg -c(;'hvmS&s^
them is their very great abundance, which though
by no means so great as to lead to the belief that
they actually compose the mist, may perhaps
account for its density and greyish or light-blue
It may be mentioned that "blights" or dense
mists, carrying innumerable fungus spores, are
not uncommon local occurrences, resulting in
the disease and destruction of many crops.
The following directions for the use of dis-
infectants, and printed on gummed paper, for
attaching to bottles, &c, have been drawn up
by Mr. Johnstone, of the Saint James's Dis-
pensary : —
CHLORIDE OF LIHE.
Four or Five handfuls to be thrown down any
place that smells badly.
CHLORIDE OE SODA.
Half-a-pint to be added to each gallon of
hot or cold water used in washing blankets,
sheets or clothes of persons ill with Diarrhoea
Half-a-pint to be added to each pail of hot
or cold water used in scrubbing floors of houses
where there is Diarrhoea or Cholera.
CONDY'S DISINFECTING FLTTID,
About a Table-spoonful to be added to each
quart of water used for washing basins, bed-
pans, &c, or the hands of persons nursing
people ill with Diarrhoea or Cholera.
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